The risk of development of end-stage renal disease (ESRD) secondary to non-insulin-dependent diabetes (NIDDM) has not yet been well defined despite the fact that approximately ninety percent of diabetics in the U.S. are of the NIDDM type. Data from our group reveal an approximate 6.5 fold excess in the incidence of diabetes- related ESRD in Mexican Americans (MAs) over non-Hispanic whites (NHWs). The age distribution of these cases suggest that the excess may be due to a predominance of NIDDM-related ESRD in MAs. However, the data base used for these analyses did not distinguish between NIDDM-related and insulin dependent (IDDM)-related ESRD. We propose to carry out an epidemiologic study of diabetes-related ESRD. A surveillance study will define the incidence of treatment of diabetes-related ESRD in MAs and NHWs secondary to NIDDM and IDDM and ethnic differences in the severity of diabetes-related ESRD at onset of treatment (dialysis or transplantation). Using a population-based design, all cases of diabetes-related ESRD in a 32 county area o( south-central Texas will be identified over a 56 month period. A one-half random sample of MA cases and all NHW and black cases will be reviewed for a total 345 cases. Another 360 cases of non-diabetes-related ESRD will also be abstracted to assess misclassification. Relevant clinical data will be obtained through chart review and patient interview allowing classification of NIDDM vs. IDDM cases as well as diabetes-related vs. non-diabetes-related ESRD. ln a concurrent case-control study, risk factors for the development of ESRD in patients with NIDDM will be investigated. Potential risk factors to be explored include age at onset of diabetes, co-morbid conditions such as hypertension and urinary tract infections, type of treatment of diabetes, and level of hyperglycemia prior to development of ESRD. In this phase 250 NIDDM-related ESRD cases and 250 NIDDM controls without ESRD will be studied. The NIDDM controls will be identified from the San Antonio Heart Study, a population-based diabetes and cardiovascular risk factor survey. Both retrospective chart reviews and subject interviews will be performed.